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Flashcards in Task 1 ADHD Deck (40)
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1

Combined presentation

If enough criterions for Inattention and Hyperactivity/Impulsivity are met

2

Predominantly inattentive presentation

If only inattentive criterions are met

3

Predominantly hyperactive/impulsive presentation

If only hyperactive/impulsive criterion are met

4

Neurodevelopmental disorder

ADHD is a neurodevelopmental disorder that means that the onset is rather early in life

5

Value of future events

Patients with ADHD discount the value of future events at a higher rate than other children (do not wait for higher reward)

6

Heterogeneity

key characteristic of ADHD
o Symptoms can take many forms (e.g. inattention or hyperactivity)
o Might be caused by the different paths

7

Path 1 (Dual-pathway model of ADHD)

dysregulation of thought and action and associated with diminished inhibitory control (dorsal fronto-striatal dysregulation/meso cortical control circuits)
 Context independent
 More severe cognitive impairment
 D1 receptor

8

Path 2 (Dual-pathway model of ADHD)

motivational style (delay aversion) associated with fundamental alterations in reward mechanisms (ventral fronto-striatal circuits/Meso limbic reward circuit)
 Children are motivated to escape or avoid delay (Delay aversion)
 Associated with reduced task engagement (start to look out of window to avoid delay of other task)
 Is more variable in view of environmental factors (e.g. parenting)
 D2 receptor

9

Developmental outcome

 Separated into behavioural symptoms (impulsiveness, inattention and overactivity) and task engagement

10

Psychological processes

primary (deficient inhibitory control) and secondary (cognitive and behavioural dysregulation) process characteristics

11

Temporal processing deficits

independent factor to the dual pathway mode
o Associated with reading problems
Working memory deficits

12

Symptoms for inattention

o Often fail to give close attention, making careless mistakes when doing e.g. homework
o Often has difficulties sustaining attention in tasks or play activities
o Often does not seem to listen when spoken to directly
o Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
o Often has difficulty organizing tasks and activities (difficulty managing sequential tasks, disorganized work; poor time management)
o Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
o Often loses things necessary for tasks or activities (e.g. pens, phone, eyeglasses)
o Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts)
o Is often forgetful in daily activities

13

Symptoms for Hyperactivity and Impulsivity

o Often fidgets with or taps hands or feet or squirms in seat
o Often leaves seat in situations when remaining seated is expected
o Often runs about or climbs in situations where it is inappropriate (Note: in adolescents or adults, may be limited to feeling restless)
o Often unable to play or engage in leisure activities quietly
o Is often "on the go," acting as if "driven by a motor" (always going)
o Often talks excessively
o Often blurts out an answer before a question has been completed
o Often has difficulty waiting his or her turn
o Often interrupts or intrudes on others (for adolescents or adults, may intrude into or take over what others are doing)

14

DSM-5 criteria for diagnose

o If six or more of the symptoms for Inattention and Hyperactivity and impulsivity are met and need to be impairing and consistent over at least 6 months
 For people older than 17 5 symptoms have to be met
o Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years
o Symptoms are present in two or more settings
o There is clear evidence that the symptoms impair normal functioning in school etc.
o The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder
 If the other disorder can’t explain the symptoms comorbidity is possible
o Age limit of 12 years

15

Gender differences

o Boys are nearly twice as likely to develop ADHD in childhood in adolescence it gets less (1.6:1)
o Girls diagnosed with ADHD show more inattentive features than boys who also show disruptive behaviour

16

Prevalence

o Affects 3 to 5% of school age children and 2.5% in adults

17

Cormobidity

20-25% have also a specific learning disorder
 45-60% develop a conduct disorder, abuse drugs or alcohol, or violate the law
 Increases the risk for antisocial PD, substance abuse, mood and anxiety disorders, legal infractions and frequent job changes in adulthood

18

Brain parts involved

o Prefrontal cortex (control of cognition, motivation and behaviour)
o Striatum (Working memory and planning)
o Cerebellum (motor activities)

19

Neurotransmitter

o Dopamine and norepinephrine

20

Immature brain hypothesis

Children with ADHD have slower development of the brain

21

Genetics

o Are strongly tied to ADHD

22

Nurture

o Triggering ADHD
o ADHD is often caused by prenatal and birth complications
o Heavy drinking or smoking during pregnancy can also cause ADHD

23

Dorsal frontostriatal pathway

involved in cognitive control (basal ganglia)

24

Ventral frontostriatal pathway

involved in reward processing (motivational deficit) (reinforcement)

25

Frontocerebellar pathway

related to temporal processing
o Shares neuro components (e.g. basal ganglia) with the other two pathways (correlation between them) but is still an own pathway

26

Impairments in timing, inhibition or delay

 Overlap between different deficits was uncommon and never greater than expected by chance – 70% of those affected showed just one deficit.

27

Stimulants treatment (e.g. ritalin)

 70-85% of the patients respond positively
 Neuro level: enhances release and inhibiting reuptake of Dopamine
 Side effects: reduced appetite, insomnia, edginess and gastrointestinal upset
 Is often misprescribed for children that are hard to control without actual ADHD

28

Atomoxentine, clonidine and guanfacine

 Neuro: affects norepinephrine levels
 Can reduce tics and increase cognitive performance

29

Antidepressants

 Used in older age when people are also diagnosed with depression

30

Behavioural therapy

o Children learn to anticipate the consequences of their behaviour to make less impulsive choices, and less disruptive behaviour
o Highly effective in reducing symptoms